(To be submitted in ten copies along with four sets of the documents)
PART A: GENERAL INFORMATION AND ACADEMIC BACKGROUND
1. Name (in Block Letters):
2. Father's Name/Mother's Name:
3. Department:
4. Current Designation & Grade Pay:
5. Date of last Promotion :
6. Which position and grade pay are you an applicant under CAS?
7. Date of eligibility for promotion:
8. Date and Place of Birth:
9. Sex:
10. Marital status:
11. Nationality:
12. Indicate whether belongs to SC/ST/OBC category:
13. Address for correspondence (with Pin code)
14. Permanent Address (with Pin code) Telephone No:
Email:
15. Academic Qualifications (Matric till post graduation):
Examinations Name of the Board/ University Year of Passing Percentage of marks obtained Division/ Class/Grade Subject
High School/Matric
Intermediate
B.A./B.Sc/B.Com/B. Mus
M.A/M.Sc/M.Com/ M. Mus
Others examination, if any
16. Research Degree(s)
Degrees Title Date of award University
M.Phil.
Ph.D./D.Phil.
D.Sc/D.Litt
17. Appointments held prior to joining this institution
Designation Name of Employer Date of Joining Salary with Grade Reason of leaving
Joining Leaving
18. Posts held after appointment at this institution:
Date of actual Joining
Designation Department From To Grade
19. Period of teaching experience: P.G. Classes (in years) : U.G. Classes (in years) 20. Research Experience excluding years spent in M. Phil / Ph. D. (In years)
21. Fields of Specialisation under the Subject/Discipline (a) (b)
22. Academic Staff College Orientation/Refresher Course attended: Name of the Course/ Summer School Place Duration Sponsoring Agency
PART B: ACADEMIC PERFORMANCE INDICATORS
(Please see detailed instructions of this PBAS proforma before filling out this section)